Pharm Exam 1

1. Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? A) "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." B) "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." C) "The order of drawing up insulin does not matter as long as the insulin is refrigerated." D) "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

A) "Draw up the clear regular insulin first, followed by the cloudy NPH insulin."

1. A patient has been given instructions about levothyroxine (Synthroid). Which statement by the patient indicates understanding of these instructions? A) "I'll take this medication in the morning so as not to interfere with sleep." B) "I'll plan to double my dose if I gain more than 1 pound per day." C) "It is best to take the medication with food so I don't have any nausea." D) "I'll be glad when I don't have to take this medication in a few months."

A) "I'll take this medication in the morning so as not to interfere with sleep."

1. A teaching plan for a patient who is taking lispro (Humalog) should include which instruction by the nurse? A) "Inject this insulin with your first bite of food, because it is very fast acting." B) "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C) "This insulin needs to be mixed with regular insulin to enhance the effects." D) "To achieve tight glycemic control, this is the only type of insulin you'll need."

A) "Inject this insulin with your first bite of food, because it is very fast acting."

1. A patient is scheduled to start taking insulin glargine (Lantus). On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A) Blood glucose control for 24 hours B) Mealtime coverage of blood glucose C) Less frequent blood glucose monitoring D) Peak effect achieved in 2 to 4 hours

A) Blood glucose control for 24 hours

1. Before administering metformin (Glucophage), the nurse should notify the prescriber about which laboratory value? A) Creatinine (Cr) level of 2.1 mg/dL B) Hemoglobin (Hgb) level of 9.5 gm/dL C) Sodium (Na) level of 131 mEq/dL D) Platelet count of 120,000/mm3

A) Creatinine (Cr) level of 2.1 mg/dL

1. A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? A) Refer the patient to a diabetes educator because the result reflects poor glycemic control. B) Glycemic control is adequate; no changes are needed. C) Hypoglycemia is a risk; teach the patient the symptoms. D) Instruct the patient to limit activity and weekly exercise.

A) Refer the patient to a diabetes educator because the result reflects poor glycemic control.

1. A nurse is developing a plan of care for a patient who has Addison's disease and is taking hydrocortisone [Cortef]. Which of these outcomes should receive priority in the plan? A. At times of stress, the patient increases the glucocorticoid dose. B. The patient wears a Medic Alert bracelet at all times. C. The patient carries an injectable form and an oral form of glucocorticoid. D. The patient divides the daily dose, taking two-thirds of it in the morning and one-third in the afternoon.

A. At times of stress, the patient increases the glucocorticoid dose.

1. The nurse teaches a patient with hypothalamic diabetes insipidus about desmopressin [DDAVP]. The nurse determines that the teaching was effective if the patient makes which statement? A."I should increase my fluid intake to prevent dehydration." B."The medication should be taken every day for 6 months." C."I can expect to urinate more often while taking this drug." D."The medication can be taken by inhaling through my nose."

A."I should increase my fluid intake to prevent dehydration."

A patient with which condition would most likely be prescribed a glucocorticoid in low doses for replacement therapy? A.Addison's disease B.Cushing's syndrome

A.Addison's disease

1. A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) A) Type 2 diabetes B) Altered fat metabolism leading to ketones C) Arterial blood pH of 7.35 to 7.45 D) Sudden onset, triggered by acute illness E) Plasma osmolality of 300 to 320 mOsm/L

B) Altered fat metabolism leading to ketones D) Sudden onset, triggered by acute illness E) Plasma osmolality of 300 to 320 mOsm/L

1. A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? A) Thyrotoxicosis B) Hypothyroidism C) Hyperthyroidism D) Graves' disease

B) Hypothyroidism

1. A patient who has type 2 diabetes is taking nateglinide (Starlix). Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? A) Inhibition of carbohydrate digestion B) Promotion of insulin secretion C) Decreased insulin resistance D) Inhibition of ketone formation

B) Promotion of insulin secretion

1. A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which finding requires immediate follow-up by the nurse? A) Skin rash B) Sweating C) Itching D) Pedal edema

B) Sweating

1. Which manifestation would the nurse most clearly associate with a tumor of the hypothalamus? A. Mood swings B. Unstable body temperature C. Irregular respirations D. Increased heart rate

B. Unstable body temperature

The nurse instructs a patient about taking levothyroxine [Synthroid]. Which statement by the patient indicates the teaching has been effective? A."To prevent an upset stomach, I will take the drug with food." B."If I have chest pain or insomnia, I should call my doctor." C."This medication can be taken with an antacid." D."The drug should be taken before I go to bed at night."

B."If I have chest pain or insomnia, I should call my doctor."

A patient with Cushing's syndrome is prescribed ketoconazole [Nizoral] 600 mg/day, before an adrenalectomy. The patient asks the nurse why this medication is needed. Which response by the nurse is best? A."The medication will prevent an abdominal infection after surgery." B."The medication will block the adrenal gland from producing steroids." C."You have a urinary tract infection that must be treated before surgery." D."It is essential to prevent skin infection in patients undergoing surgery."

B."The medication will block the adrenal gland from producing steroids."

A patient takes levothyroxine [Synthroid] 0.75 mcg every day. It is most appropriate for the nurse to monitor which laboratory test to determine whether a dose adjustment is needed? A.Thyrotropin-releasing hormone (TRH) B.Thyroid-stimulating hormone (TSH) C.Serum free T4 test D.Serum iodine level

B.Thyroid-stimulating hormone (TSH)

1. A patient with Graves' disease is treated with iodine-131 (Iodope) therapy. Which statement by the patient would indicate understanding of the treatment's effects? A) "I'll have to isolate myself from my family so I don't expose them to radiation." B) "I'm looking forward to feeling better immediately after this treatment." C) "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." D) "I'll need to take this drug on a daily basis for at least 1 year."

C) "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance."

1. A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? A) Take the patient's blood pressure. B) Give the patient's PRN dose of insulin. C) Check the patient's capillary blood sugar. D) Advise the patient to lie down with the legs elevated.

C) Check the patient's capillary blood sugar.

1. A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecystectomy. The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning. The patient's surgery is scheduled for the next morning. The nurse will expect an order to: A. administer the usual morning dose of hydrocortisone 25 mg PO. B. administer hydrocortisone 50 mg PO in the morning. C. administer hydrocortisone 50 mg IV before surgery. D. withhold the morning dose of hydrocortisone and give it after surgery.

C. administer hydrocortisone 50 mg IV before surgery.

1. A pediatric patient is prescribed somatropin [Humatrope] for growth hormone deficiency. It is most appropriate for the nurse to take which action? A.Perform a venipuncture to give the medication intravenously. B.Obtain a straw to prevent staining of the tooth enamel. C.Draw up the drug into a syringe and give it subcutaneously. D.Mix the medication in 30 mL of fruit juice.

C.Draw up the drug into a syringe and give it subcutaneously.

A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats/min, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition? A.Cretinism B.Graves' disease C.Hypothyroidism D.Hyperthyroidism

C.Hypothyroidism

1. A patient who has been newly diagnosed with adrenal hormone deficiency will begin taking hydrocortisone. The nurse provides teaching for this patient. Which statement by the patient indicates understanding of the teaching? A. "I may take all of my daily dose in the morning or divide it in half and take it twice daily." B. "I will need to take this medication until my symptoms completely clear, and then I may stop." C. "Side effects are common with hydrocortisone, even with therapeutic doses." D. "When I am sick, I should take three times the normal dose for 3 days in a row."

D. "When I am sick, I should take three times the normal dose for 3 days in a row."

1. A patient with Cushing's syndrome has undergone surgery and radiation treatment. The nurse will expect to teach the patient about which medication? A. Cosyntropin B. Dexamethasone C. Fludrocortisone acetate [Florinef] D. Ketoconazole [Nizoral]

D. Ketoconazole [Nizoral]

The nurse teaches a patient with Addison's disease about hydrocortisone replacement therapy. Which statement, made by the patient, indicates that the teaching was effective? A."I can expect my blood sugar levels to be high." B."If I become ill, the dose needs to be reduced." C."It's important to take the medication at bedtime." D."I should keep an emergency supply of this drug available at all times."

D."I should keep an emergency supply of this drug available at all times."

A patient with hyperthyroidism is taking propylthiouracil (PTU). It is most important for the nurse to assess the patient for which adverse effects? A.Gingival hyperplasia and dysphagia B.Dyspnea and a dry cough C.Blurred vision and nystagmus D.Fever and sore throat

D.Fever and sore throat

An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."

a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes."

The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats/min who is about to receive digoxin [Lanoxin] c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin]

a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin

Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime

c. Once daily at bedtime

1. A patient with type 1 diabetes is eating breakfast at 0730. Blood sugars are on a sliding scale and are ordered AC and HS. The patient's blood sugar level is 317. Which of the following formulations of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Regular

d. Regular